CBO: 24 million fewer insured under House bill repealing Obamacare

Roughly 24 million more people would be uninsured over a decade if the House Republican Obamacare repeal bill is enacted, according to a much-anticipated Congressional Budget Office analysis that could threaten GOP hopes of getting the measure through the House in the coming weeks.

The legislation would lead to 14 million more people being uninsured in 2018 alone. The nonpartisan scorekeeping office also forecast the GOP plan would cut the deficit by $337 billion over a decade, primarily because of the legislation's cuts to Medicaid and private insurance subsidies.

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The prediction of coverage losses provided immediate fuelto Democratic arguments that the people who signed up for coverage under Obamacare will be much worse off under the House GOP plan. The numbers could also cripple Republicans’ hopes of passing legislation before the April recess, coming as both conservatives and moderates express misgivings about the plan. In total, CBO estimated that 52 million people in the U.S. would be uninsured in 2026 if the House bill became law, completely wiping out the insurance gains that have been made under Obamacare over the last seven years.

Moderate Republicans worried about precisely the kind of coverage losses the CBO predicted have balked at supporting the House bill. GOP leadership also caught flak from conservatives who criticize the bill as “Obamacare lite” because of the new age-adjusted tax credits it proposes. And some Republican governors who expanded their Medicaid programs under Obamacare have publicly fretted about whether they will have to drop low-income people from the rolls to avoid bankrupting their states.

"This is a work in progress and obviously we want to improve those coverage numbers. But when you don't punish people financially for their refusal to buy government approved insurance, people are gonna make a decision not to buy it," said Sen. John Cornyn of Texas, the chamber's no. 2 Republican.

Republicans in the past week tried to discredit CBO’s forecasts in anticipation of the bad news while maintaining that no one will be worse off under the GOP plan. Lawmakers continued to do so on Monday after the score was released.

"CBO scores, there are times that I've had real problems with them, especially on agriculture and what that means ... I'm not saying I don't have any trust or faith in CBO, I'm just saying that you gotta sorta take it with a little bit of salt,” Sen. Pat Roberts (R-Kan.) said.

Apart from rolling back the law’s Medicaid expansion beginning in 2020 and making other sweeping changes to the health law, the GOP plan would revamp the entire Medicaid program and cap federal spending based on the number of enrollees by state. The bill is paid for with a staggering $880 billion cut to Medicaid over a decade, a figure that is likely to terrify governors who rely on the existing federal share of the program for their budgets.

The House bill also repeals many of the health law’s taxes in 2018, axes the unpopular mandate requiring most people to purchase insurance and defunds Planned Parenthood for one year. The GOP repeal bill would cut $673 billion by eliminating the ACA’s subsidies, CBO said. The tax credits in the Republican bill would cost $361 billion. Generally, the CBO said low-income people would face higher costs than they do under Obamacare.

The tax credits would be larger for those with higher incomes, particularly for those with incomes above 400 percent of the federal poverty line, which is the cap for Obamacare’s existing subsidies.

The analysis also delves into effects on health insurance premiums over the next decade. Insurance premiums would rise in 2018 and 2019 under the GOP plan, by as much as 15 percent to 20 percent for single policyholders in the individual market, according to CBO. Much of that increase would be because without the mandate, fewer healthy people would sign up.

In 2020 and afterward, premiums would decline as the effects of the eliminated mandate would be offset by other factors in the Republican plan. By 2026, premiums would be roughly 10 percent lower than under Obamacare.

CBO warns that there would be significant variability for different age groups because the repeal bill would eliminate Obamacare’s requirement that older people can be charged only three times as much as younger individuals.